The Future Doctor Programme - A co-created vision for the future clinical team - Health Education England
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The Future
Doctor Programme
A co-created vision for the future clinical team
Table of Contents
1 Foreword 1
2 Introduction 5
3 Methodology 8
What are the Unique Characteristics
4 of Future Doctors? 10
5 Overarching Themes 17
6 Conclusion 49
7 Next Steps 51
8 References 53
1 Foreword Foreword
For some, it will not go far enough or fast enough, and for others, it will feel like too much
too soon. However, with the learning from the changes made during the pandemic, this
gives the profession, the public and the NHS a starting point.
The Future Doctor co-created vision is the culmination of significant work and
Over the last four years, Health Education England has system-wide engagement. It sets a clear direction for the next phase of our reforms.
led a collaborative effort, on behalf of patients, the For this vision to be realised, we must now work together to bring fundamental change
profession and the NHS, to co-create reforms across in how doctors train now and in the future, and establish a supportive culture within the
medical education and training. system that values its workforce.
Our work to this point has made significant strides in liberalising training; creating I want to thank all those involved and, in particular, Professor Sheona McLeod, Sam
greater flexibility in how doctors work and train to enable more varied and fulfilling Illingworth and Tahreema Matin, who have listened, reflected and got us all to this point
careers; ensuring consistent and supportive assessment and progression; providing in the reform journey.
greater support to doctors in the transition into and through the early stages of their
careers; and more recently, working with the health and care system and national
Educational Bodies to better align the choices doctors make in training to the health
needs of the populations they service.
We have seen how quickly and effectively the medical profession can change in
response to the coronavirus pandemic where re-deployment, generalist clinical skills
and new clinical teams were central to the service meeting the challenge.
Professor Wendy Reid
Improving the quality of medical education and training has always been our central Acting CEO Health Education England
thread, illustrated through the publication of our annual Enhancing Junior Doctors
Working Lives report, to ensure that we train and retain more doctors equipped with the
skills that the future NHS needs.
I have been impressed by how our stakeholders and partners, with us, have been
prepared to think differently, challenge the current construct of medical education and
training, and consider a new future, from medical school through postgraduate training
and beyond, which will greatly benefit patients and the health and care system.
The Future Doctor sets us a collective challenge to make a fundamental shift in medical
education from a system that places disproportionate value on specialism to one
that recognises crucial value in a generalist training; that better equips doctors in the
management of complex care, co-morbidities, and provides a deep connection and
understanding of the communities doctors serve; and instils strong professionalism
from the start of medical education and training.
1 2Foreword Foreword
Our stakeholders and partners were clear about an expectation for Future Doctors
to have both ‘extensivist’ and ‘generalist’ skills. An extensivist/generalist must have a
greater breadth of practice across disciplines/specialties as well as a strong bedrock
HEE launched the Future Doctor Programme last year, of generalist clinical skills to deliver complex, comprehensive care across different
linked to work on the NHS People Plan, to inform and healthcare environments. The recent learning from how health and care has responded
galvanise change in medical education and training to the COVID-19 pandemic has illustrated a requirement for the Future Doctor to be
to achieve the vision for future healthcare as set out able to adapt to different patient groups and clinical environments to meet the needs
in the NHS Long Term Plan. of those in their care.
The recent urgent actions that we have collectively needed to take across the NHS to We heard that Future Doctors would need to adopt a value-based and population
respond to the COVID-19 pandemic have reinforced many of the themes and findings health approach to the delivery of future care. This will necessitate a place-based
we heard during our Future Doctor engagement. It has also highlighted that the pace approach to education and training, with Future Doctors needing to develop a sense
and scale of change can alter when patient care is at stake. Ensuring our Future of community responsibility early on in their career. By working across organisational
Doctors are valued, fully supported and equipped to deliver high-quality 21st century boundaries, Doctors trained in this way will use resources optimally to improve the
care in response to the demands of a complex, ever-changing healthcare system has physical, mental and social wellbeing of the populations they serve.
never been more relevant than now. We heard that flexibility in training and working was essential for retaining a motivated
As we publish this Future Doctor report, I would like to thank all those who have workforce and that the flexibility reforms from Enhancing Junior Doctors’ Working Lives
contributed to this collaborative piece of work. It has been rewarding to be part of the must proceed at pace. We also heard that doctors’ aspirations for stimulating and
innovative thinking that the programme has stimulated and to see how all involved rewarding lifelong careers aligned with the service’s vision: flexible medical careers that
have challenged current assumptions about doctors, their education and training. enable adaption to changing population needs.
Stakeholders and partners provided perspectives from medicine and other healthcare The co-created vision for the role of Future Doctors in the future clinical team, as
professions, service providers, regulators, charities, patients and carers. presented in this report, has been made possible by the enthusiasm of stakeholders
The future of healthcare is unknown, and change is inevitable. This report makes it clear across the system. I would like to thank everyone, including patients, NHS bodies across
that Future Doctors and other multi-professional team members need to be able to the UK, education providers and employers, professional and regulatory bodies, current
adapt to a constantly changing future healthcare environment. doctors and students, plus the many other healthcare professionals whose feedback
has directly shaped this work. This spirit of collaboration will enable us to drive reform
The report provides a definition of the unique characteristics of Future Doctors within
to ensure the workforce is fit for, and enthusiastic about, the future. I would also like to
future clinical teams, alongside eight key themes to help us to prioritise the reform of
thank Tahreema Matin for helping me to lead this work and co-author this report.
medical education and training.
Right from the beginning of the Future Doctor Programme, we heard the patient must
remain firmly front and centre and will always be the most important member of
the future clinical team. The changing patient-doctor relationship will require Future
Doctors to embrace supported shared decision making but ensure the core aspects Professor Sheona MacLeod
of care-giving - humanity, compassion, face-to-face contact and human touch - are Acting Director of Education and Quality & Executive Medical Director
never allowed to be diminished.
3 42 Introduction Introduction
The Future Doctor Programme provides a clear view of what the NHS, patients and the The following key emergent themes of the Future Doctor Programme will help us to
public require from future doctors within a transformed multi-professional team. This prioritise the next stage of medical education reform: -
co-created vision for the future has also identified much of what is required to respond
to the projected demands and needs of the workforce in the future.
There are many future challenges that will impact on the role of the doctor. For
example, different patient expectations of the patient-doctor relationship and
1 Patient-Doctor Partnership
technological developments, such as artificial intelligence and genomics, will radically Doctors in the future clinical team have the patient firmly front and centre to
change healthcare delivery models. It is clear from our programme that an evolved promote supported shared-decision making and enable patients to make the
undergraduate and postgraduate medical training system will be required to deliver best use of available care and support.
this future.
The Future Doctor programme employed robust and novel methodology to achieve 2 The Extensivist and Generalist
widespread engagement across the system and harness the expertise of our
Future Doctors will have confidence in a greater breadth of practice across
stakeholders and partners. This included regional feedback, a formal call for evidence,
disciplines and specialties due to a strong base of generalist skills, which will
future scenario development, national stakeholder events and focus groups. This final
enable them to deliver complex, comprehensive care managing co-morbidities
Future Doctor report details the co-created vision; the unique behaviours and skills of
in changing healthcare environments.
future doctors and the key overarching themes relating to their role within the future
clinical team. This vision is informing reform priorities for medical education and
training, building on successful changes already implemented through HEE’s Medical 3 Leadership, Followership and Team Working
Education Reform Programme.
Future Doctors will demonstrate compassionate and collaborative leadership
and effective teamworking.
The Future came sooner than we thought: 4 The Transformed Multi-professional Team
One of the comments from those responding to our engagement believed that, despite
the need for change, our aspirations for reform within a few years would fail without Future Doctors will espouse and promote a culture where each member of the
some significant event: multi-professional team is acknowledged, respected, valued and empowered
to accept shared responsibility. Doctors will promote other healthcare roles to
“A geopolitical crisis, major global recession or cataclysmic pandemic will be the patients and the public.
most likely driver of change. With all the will in the world, without a step-change in the
money and power available, current planned changes in how health and social care in
the UK will be delivered will be at best partial.”
5 6Introduction 3 Methodology
How the Future Doctor was Co-created
5 Population Health and Sustainable Healthcare HEE engaged all sectors across health and care as well as interested external experts
and patients. To compile, collate and create this co-created vision, data was derived
Future Doctors will learn, while embedded in their local community, to better from four key areas, supplemented by novel methodology using future scenario
understand population needs and use resources optimally to improve the development.
physical, mental and social wellbeing of the whole population. They will embrace
a culture of stewardship and a sense of community responsibility.
Regional Feedback – Acknowledging regional differences and demands, feedback
from service leadership across England was sought.
6 Adoption of Technology
Technology will be employed by Future Doctors as an enabler for change in Literature Review – A formal literature review establishing the evidence base to
clinical care and in education (e.g. remote supervision and care delivery and AI inform the emergent themes relating to the future clinical team was carried out.
augmenting clinical decision making). This included a broad range of scientific papers, medical reports and consultations.
The NHS Long Term Plan, The Interim People Plan and technology projections
(courtesy of the TOPOL Review) also guided subsequent discussions.
7 Work-life Balance and Flexibility Throughout a Career
Future Doctors will have flexibility in training and working, with access to portfolio Call for Evidence – In August 2019, the Call for Evidence captured expert views of
careers and lifelong learning opportunities for changing careers. patient and service representatives from across the healthcare sector, including
the perspectives of regulatory bodies, clinical professionals and professional
membership bodies.
8 Driving Research and Innovation
Every Future Doctor will be a scholar and will support patients to make informed
National Conversations – The iteratively developed co-created vision was tested
choices around engaging in research. Future clinical academics will be local
and refined with a broad range of stakeholders through a series of national events,
leaders in co-ordinating local, regional and national research and innovation.
scenario planning workshops, and subsequent focus groups to seek expert opinions
on the implications of the emerging vision for the future and resultant reform of
medical education and training.
These themes have never been more pertinent than in the context of the current
COVID-19 pandemic. The need for a flexible, engaged, empowered and motivated
medical workforce has been illustrated through the healthcare system response
to COVID-19. We have an opportunity to realise the potential of the system wide
collaborations and rapid health and care responsiveness in the context of COVID-19 to
take decisive action to deliver positive reform that will enable us to meet the needs of a
rapidly changing health and care system.
7 8What are the Unique
Methlodology 4
Characteristics of Future Doctors?
The use of Scenarios provided a framework for discussions about the future, based on Metaphors for Future Doctors can help describe the collective view we heard of the
credible, plausible and challenging intelligence to illustrate what life might be like for unique characteristics of Future Doctors.
patients and doctors working and living in a range of possible future environments.
Applied Wisdom
For further information, please refer to our supporting document, which outlines each
Maestro Ethicist
scenario used to support and inform the Future Doctor Programme.
Carer
Mechanic/Plumber
General themes emerged with each scenario and the relative importance of the Artist Professional
impact these might have on healthcare education and training policy and strategy Maverick
Detective
Humanitarian
were refined during the course of the engagement through a process of ‘wind
Diagnostician
Scientist
tunnelling ’.
Priest Guru
Defining the unique characteristics of future doctors enables further exploration of
their profession identity and working relationships with patients, carers, colleagues and Philosopher Disrupter
Politician
multi-professional team members, looking to 2030 and beyond.
Patient Engineer
The outcomes of this programme are defined as:
The unique characteristics of Future Doctors within future clinical teams.
Applied wisdom is the ability of doctors (current and future) to use their intellect,
Eight key themes of priorities for the next phase of evolution and reform in medical
training and experience to make complex clinical judgements. The Future Doctor will
education and training.
be expected to retain both the science and art of practising medicine, supported by
technology, a broad knowledge base, significant clinical experience, technical skills
proficiency and wisdom.
Advanced technology, for example clinical decision-aid tools and algorithms, may
streamline, facilitate and supplement Future Doctors’ skills. However, the consensus
view was that this could not substitute for Future Doctors, and that the unique skill
of doctors being independent thinkers and able to step outside of guidelines and
protocols safely and confidently is critical for future healthcare delivery.
9 10What are the Unique Characteristics of Future Doctors? What are the Unique Characteristics of Future Doctors?
The Patient Advocate The Academic Through Clinical Training
Enabler Catalyst For Change
Scientist
IT Expert
Supporter Data Scientist Innovator
Team Member
Learner
Patient Advocate
Champion
Scholar Creator
Researcher
Academic
Partner Analyst
Entrepreneur
Patients and the public value interpersonal relations and technical skill in their doctor,
as well as humaneness, competence, being listened to, being provided honest Doctors are highly educated, training for longer than other healthcare professional.
information about their illness and treatment options with sufficient consultation time Future Doctors will be trained to access and critically appraise the vastly changing
and involvement in the decisions about their care.(1-3) andgrowing amount of knowledge required to perform their role and promote
evidence-based medicine. By harnessing the skills of effective lifelong learning; being
The Future Doctor will ensure they foster a rapport and partnership with their patients
agile, adaptable and open to change; focusing on promoting research and innovation;
based on individual preference, supporting shared-decision making, promoting health
and using their influence to promote improvement, the Future Doctor will be a catalyst
and preventing illness with a person-centred, personalised approach.
for change.
Future Doctors will be trained to access and critically appraise the vast changing and
growing amount of knowledge required to perform their role and promote evidence-
based medicine.
11 12What are the Unique Characteristics of Future Doctors? What are the Unique Characteristics of Future Doctors?
The Ability to Hold Uncertainty
The Extensivist and Generalist and Evaluate Risk
Health and Wellbeing Promoter
Risk Analyst
Employee
Life Coach
Employer
Resource Manager
Supervisor
Economist
Generalist
Line Manager
Risk-taker
Holistic Expert
Decision-maker
Healthcare Navigator Administrator
Judge
Accountable
Population Health Champion Business Manager
Future Doctors will also have a deep and nuanced understanding of the healthcare Doctors are able to make valued judgements and hold on to uncertainty. They
needs and priorities of the populations they serve. This, coupled with a robust evaluate risk and often act as the final decision-maker. Being accountable and
knowledge about the wider healthcare system, will enable Future Doctors to work taking responsibility for themselves, the patient, junior colleagues and wider multi-
collaboratively with other healthcare professionals and disciplines to implement professional team members is a fundamental skill of all doctors.
innovative ways to improve the quality of healthcare service delivered.
With an increasingly complex healthcare system in a changing environment, Future
Future Doctors will enable their patients and the communities they serve to foster a Doctors will be experts in managing uncertainty and ambiguity and evaluating risks
culture of innovation and develop bespoke health improvements. They will be able and benefits to patients and populations. Future Doctors will need to support others
to understand the needs of individuals and populations and have a broad range of in developing and using these skills as the expertise in the multi-professional team
generalist clinical skills that are applicable across different specialties and healthcare develops.
environments.
13 14What are the Unique Characteristics of Future Doctors? What are the Unique Characteristics of Future Doctors?
The Leader The Translator of Knowledge
Follower Expert Communicator
Chronicler
Orator
Role Model
Chair
Advisor
Conductor Mentor Listener
Translator
Story-teller
Leader
Guide
Negotiator
Teacher
Counsellor
Educationalist
Librarian
Therapist
Referee Interpreter Sage
Challenger
Facilitator Sign-posting Expert
The Future Doctor will demonstrate respect and understanding for other multi-
professional team members and be fluent in leading, and following, as effective team
players.
The Future Doctor will be an expert communicator, able to transfer knowledge and
They will be strong advocates for the multi-professional team and support others to increase the understanding of patients and their carers, other healthcare professionals,
lead, depending on the clinical context and environment, to ensure optimal patient communities and external groups involved in health and care.
outcomes.
By listening to patients, understanding their preferences and involving them in
decisions about their care, a more patient-centred approach to clinical consultations
will promote improved patient satisfaction(4). The need to help guide patients through
complex healthcare systems will become increasingly important as a shift from
reactive to preventative medicine occurs in the future.
The Future Doctor will also support learning and inspire the next generation of clinicians
as educators for all healthcare professionals in a multi-disciplinary educational
team with sufficient resource to fulfil these supervisory, mentorship and support roles.
They will maintain their own health and wellbeing and ensure this is a priority for the
healthcare workforce.
15 165 Overarching Themes Overarching Themes
There are eight key overarching themes relating to the role of the Future Doctor that
have emerged from our engagement and co-creation.
Patient-Doctor Partnership
The vision for the future clinical team has the patient firmly front and centre. We heard
that to think and work in a way that ensures the patient’s perspective is central, doctors
will need to be experts in the following:
Relationships and Communication
The core skills and behaviours that we heard emphasised that patients and the public
will expect echo those most highly rated within the literature(5):
Humaneness, compassion
Competence, accuracy, safety
Patient involvement in decisions
Time for care(6)
Ability to signpost appropriately through understanding of how their local health
and care system works.
Interpersonal skills are based on trust and require a combination of honesty, openness,
responsiveness and having the patients’ best interests at heart.(7)
17 18Overarching Themes Overarching Themes
Expert communication skills with patients, their families and colleagues will remain We heard that patients want Future Doctors to empower patients to manage their
fundamental for Future Doctors. Effective communication has been demonstrated own health and wellbeing according to individual preferences and capabilities.
to positively influence patient behaviour and reduce the risk of medical negligence However, this must not place undue burden on the patient. Future Doctors will need
claims.(8) However, skills such as motivational interviewing will become increasingly to be sensitive to the needs of diverse populations within different communities and
relevant as healthcare moves towards promoting healthy living and disease cultural contexts and embrace their responsibility to reduce health inequalities by
prevention. working flexibly with different patient populations. The Future Doctor will therefore
require training in cultural awareness and to develop an understanding of local health
Patient satisfaction is strongly associated with the provision of information and
population and cultures.
opportunities for participation in healthcare decision-making,(1) and patients
increasingly expect to participate in decisions about their care.(9,10) The Future
Doctor will therefore require communication skills with a greater focus on supporting Patient Advocacy
prevention, shared decision making and shared responsibility. As digital consultations
Patients want doctors to act as patient advocates and help them navigate
and online healthcare environments become more prevalent, learning for excellent
the increasingly complex healthcare system, promoting supported or shared
digital communication skills will also be imperative.
responsibility, as described by the King’s Fund. Doctors need to be able to share
The future patient-doctor relationship will require doctors to understand local systems knowledge about health and disease and complex health and social care pathways
and available support; for example, services provided by third sector organisations. with patients, their families and carers.
This will enable Future Doctors to signpost patients, carers, colleagues and healthcare
partners appropriately.(11)
Patient-centred and Personalised Care
While timely access to healthcare close to home was a patient priority, this view was
Future Doctors need understanding of the therapeutic power of the patient-doctor
balanced by maintaining patient safety as paramount and doctors paying attention to
partnership and to be fluent in providing empathy, support and reassurance with
their own wellbeing to be able to provide the best care.
honest information about patients’ conditions, options for treatment, the risks and
potential harms of medical interventions, while listening carefully to concerns and
Patient Empowerment personal preferences.(12) Shared decision making and a consistent patient-centred
approach will improve patient satisfaction,(4) as the application of genomics, digital
Increased access to information online and health/lifestyle data collected from smart
medicine and artificial intelligence enables more personalised care.
devices and apps mean patients are able to research their conditions and engage in
treatment plans more than ever before. Future Doctors will have an important role in We heard that, as medicine and science advances humaneness, compassion, face-
helping patients filter this information, eliminate potential “fake news” and know which to-face contact and the human touch will remain vital to the future patient–doctor
information sources may be trusted as recommended in The Topol Review; Preparing partnership. A new culture of Doctor wellbeing must be fostered to enable the delivery
the healthcare workforce to deliver the digital future. of compassionate, high-quality patient care.
Future Doctors will promote increased patient and public awareness about the role Future Doctors must recognise the complexity and vulnerability of their patients and
of other multi-professional team members. They will be advocates for the future strive to use advances to treat disease, relieve suffering and promote health with
clinical team, helping patients access the most appropriate professional by increasing human honesty and compassion.
understanding about the care other multi-professional team members are competent
and better placed to deliver.
19 20Overarching Themes Overarching Themes
Lessons Learnt from COVID-19: How Must Education and Training Adapt?
The rapid adoption of online and telephone consultations during COVID-19 is likely Greater focus on supporting meaningful prevention, shared decision making and
to result in an acceleration in the virtual delivery of many services in primary care shared responsibility as a core part of communication skills teaching
and out-patient secondary care. The Future Doctor will be proficient in assessing
Accelerating and embedding learning for excellence in digital communication skills
and communicating with patients and families using new technologies, while
ensuring there is time for patients when care in person is required. Learning grounded in understanding the needs of communities within local
systems, which should start at medical school, enabling the appreciation of support
COVID-19 created an environment that broke down healthcare system barriers
available, including community and third sector assets
and encouraged cross-sector team-based thinking, framed around the needs of
individual patients. The ability to navigate the local healthcare landscape and work Training doctors to have an understanding of local health population and cultures
in collaboration, highlighted in the Future Doctor work, was crucial for our clinicians.
Embracing a culture of doctor and team wellbeing as central components of
COVID-19 has shone a light on inequalities in the ability to access healthcare for compassionate, high-quality patient care
some patient groups. Expertise in new and emerging remote care delivery models
supported ‘hard to reach’ patient groups, such as rural and shielding patients. This
demonstrated the potential for addressing some inequalities by improving the
ways patients can access care. The Future Doctor will be cognisant of the needs of
different patients in care delivery.
COVID-19 reinvigorated concerted efforts to focus on staff wellbeing in order to
enable compassionate, high-quality care. This encouraged all staff to take greater
ownership of their own and their colleagues’ wellbeing. Trusts provided significant,
locally available support. This included local peer support, such as WARD, which
was widely accessed, showing the value of peer support and the importance of
team approaches to wellbeing.
21 22Overarching Themes Overarching Themes
While Future Doctors will still be required to develop specialist skills and expertise, this
may be considered within the T-shaped employee model well established in industry.
The Extensivist and the Generalist Future Doctors will have a broad range of generalist skills across many disciplines
(the horizontal part of the T) with the capacity to adapt and develop deep expertise in
different areas across their career (the vertical part of the T).
In a context of increasing multimorbidity across communities, we heard clearly that
Future Doctors must have a strong bedrock of generalist skills, which can be transferred Broad Range of Generalist Skills
and extended over the course of a career. and Cross Discipline Competence
Access to generalists in primary and secondary care will prevent patients from seeing
multiple specialists, which costs patient time and risks fragmented care, duplication
and waste.(13) All Future Doctors will therefore need broader training, focused on the
management of multimorbidity. T-shaped Future Doctor
Changing medical and social perspectives will value holistic rather than disease-
centred medicine, prompting a shift towards health promotion and social
accountability, underpinned by a broad generalist knowledge base.(14) Medical
education and training will require a greater focus on holistic care, with the promotion
of health and social accountability.
Generalists working in any area of medicine have professional knowledge, skills and
experience, enabling them to manage patients with complex co-morbidity.
Augmenting specialist learning by developing these skills will provide Future Doctors
with the confidence to manage complex care throughout their postgraduate training
and medical careers.
Deep Expertise
23 24Overarching Themes Overarching Themes
Lessons Learnt from COVID-19: How Must Education and Training Adapt?
The pandemic highlighted the importance of managing multimorbidity. Doctors A fundamental shift in training to enable a broad focus on managing
needed to see the “person” not the “diseases” to take tough interventional multimorbidity for all Future Doctors
decisions, considering how comorbidity influences personal, social and health risks.
Enhance the generalist skills and competencies of all doctors that are crucial in
This occurred both in hospitals and the community.
developing confident and adaptable doctors, with the significant value of these
There is a greater appreciation amongst doctors and the public of the impact that skills needing to be acknowledged, recognised and valued
social factors, such as isolation as a result of lockdown, can have on mental and
A significantly greater focus on providing holistic care, including the promotion of
physical wellbeing and of the wider health risks associated with multimorbidity,
health and social accountability
disability and frailty.
Redeployment of doctors provided development opportunities, with trainees being
rapidly upskilled in acute and emergency procedures. Many trainees were able to
demonstrate their transferable skills; however, many experienced anxieties about
their capabilities in being redeployed. A deeper generalist training, with more
regular opportunities to maintain these skills, could help prevent this in the future.
A rapid increase in respiratory and critical care skills was required to meet patient
needs. This supported the Future Doctor findings that postgraduate training should
provide more opportunities to gain additional competencies in different specialties,
particularly those grounded in generalist expertise.
COVID-19 has given many doctors a greater understanding of working in
emergency settings, of rapid upskilling for new environments, and of infection
control and personal protection. This learning needs to be maintained to enable the
NHS to resume core services across reconfigured community and secondary care
settings while managing the ongoing persistent challenge of COVID-19.
25 26Overarching Themes Overarching Themes
This aligns with the core leadership attributes within the literature and medical
leadership standards(22) and frameworks(23, 24):
Leadership
Self-awareness and self-development
• Creating and communicating their vision, setting clear direction
• Awareness of self and others
Leadership and Followership • Balancing competing interests and priorities and manage themselves
We heard that leadership values and behaviours will be core attributes of Future effectively; to enhance peer credibility
Doctors as medical leadership improves the quality of care, patient safety, provision Personal resilience, drive and energy
of cost-efficient care and organisational performance. (15-18)
A key theme emphasised
• Possess, voice and enact resilient personal values and beliefs that positively
by many was the need to clearly define what both good leadership and followership
impact the future clinical team and place the patient at the centre of decision-
means for each member of the multi-professional team in the NHS.
making.
All Future Doctors will need to learn about team working and followership, a
Team player/Team leader
concept that acknowledges the importance of participation and allowing others to
lead as complementary skills to leadership.(18,19) Lord Darzi’s reviews(20,21) and the NHS • Working collaboratively and networking
Long Term Plan highlight that great quality care needs great leadership, as well as a • Cross-team collaborations
culture of compassion, inclusion and collaboration across the NHS.
Corporate responsibility
Patient-centred care requires an in-depth understanding of team working, including
• Knowledge about funding, organisation, governance and management within
flexible leadership across professional boundaries, dependent on the individual patient
the NHS and well-developed systems and organisational culture to encourage
and clinical situation. Future Doctors need to learn about leadership, followership and
performance improvement
effective team working, embracing collaborative and compassionate leadership
• Service re-design and healthcare improvement
to enable health and care colleagues to do more for patients. They must have a
comprehensive understanding of other health and social care professions and be System leadership
trained as role models for team working and advocates for other professions, enabling
• Effective negotiation
the full contribution of all members of the future clinical team.
• Understand the political, economic, social and technological drivers that
influence the healthcare landscape, enabling a macroscopic view on
What Will Make Future Doctors Good Leaders? healthcare provision and resource allocation throughout their careers
Good leadership requires skills including self-awareness; strong communication and
interpersonal skills; professionalism and fairness; and the confidence to challenge,
question and understand the future clinical team and roles of each multi-professional
team member.
27 28Overarching Themes Overarching Themes
Leadership Training
We heard that Future Doctors should develop an appreciation of leadership, including How Must Education and Training Adapt?
followership, at an early stage, starting at medical school. Many medical schools have
begun this,(25) and leadership competencies are included in postgraduate medical
Doctors need to learn that followership is a key skill and attribute in leadership and
training programmes.(26) However, ensuring leadership development is given parity with
is crucial for effective team working. They should be able to role model this in team
achieving clinical and academic competencies is critical.
working and advocate for other professions in teams, so all can fully contribute.
An understanding of the skills, attributes and unique expertise of other professions
is essential in their development. This should be emphasised throughout their
Lessons Learnt from COVID-19: learning, starting in medical school.
COVID-19 has demonstrated the power of effective leadership and followership.
Within a few weeks, our healthcare workforce adapted to new ways of working.
Rapid decision-making was enabled by different groups working collaboratively,
both within locations and across the globe, to solve shared issues. Fast turnaround
teams were able to lead change and were freed from traditional ‘command and
control’ models often seen in times of crises.
Our workforce demonstrated great flexibility in leading and engaging with these
changes. Leadership was not a positional aspect of the doctor, but rather a quality
deployed by the most appropriate person in the situation in the interest of patients.
Distributed leadership across professional silos, cross-specialty working, shared
decision making, and greater shift working across all grades to meet patient needs
gave new expanded teams a shared purpose and boosted morale.
Trainees could see leadership in action, being role modelled across senior clinicians
within teams, and should be encouraged to reflect on this. For example, who in the
organisation/team did staff identify as leaders? Who did they identify as decision
makers? Why? What behaviours were displayed by those who ‘led’?
29 30Overarching Themes Overarching Themes
Breaking Down Silos – How can the Future
The Future Doctor in a Transformed Clinical Team be Realised?
Multi-professional Team We heard from all stakeholders that doctors need to develop alongside other
healthcare professions, with professional bodies working more closely together to
define the multi-disciplinary skills and values of the future clinical team.
The ‘hidden’ curriculum,(27) which impacts learner behaviours and attitudes
and reinforces professional silos, must be changed by supervisors and mentors
The Future Clinical Team – Defining the Vision championing a collaborative inclusive culture where healthcare professions are able
to speak up and shared responsibility is accepted. This is currently enabled by multi-
The future clinical team will be multi-professional and multi-agency, including social
professional workplace supervision and the teaching of junior doctors.
care, voluntary and third sectors.
We heard that there should be development and recognition of generic competencies
Acknowledging, respecting and valuing each member of the multi-professional
across and within healthcare professions. Education reform should also proactively
team will be critical to establishing a future clinical team where each individual
address the hidden curriculum that maintains silo mentality.
retains a strong sense of professional identity and each has a clearly defined role.
Understanding the unique characteristics of doctors and all healthcare professionals
and their shared skills and competencies will enable patient care to be provided by the Empowering New and Extended Roles
right person based on knowledge, skills and competencies rather than professional title
Achieving the future clinical team vision in a changing societal and clinical
or role.
environment will also require the anticipation of new and emerging roles, as well as
There must be more opportunities for Future Doctors to collaborate together with other sufficient time and resource for the supervision and development of these roles.
professions to develop shared competencies and obtain a nuanced understanding of
Future-proofing new roles and the service transformation associated with them
the unique attributes of different professions.
through adequate investment and support across the healthcare system is essential,
We heard that the future clinical team vision will require a cultural shift away from as is clarifying the scope of practice and the regulation of new healthcare professions.
professional protectionism, an understanding and acceptance of others’ skills and The need for adequate support for Advanced Clinical Practice roles was repeatedly
capabilities, close communication and collaboration across the healthcare professions highlighted.
and collapsing of traditional vertical hierarchies. This aligns with recent work by the
Academy of Medical Royal Colleges.
The clinician leading and delivering care during different parts of the patient pathway
should be driven by region-specific factors, such as available workforce capabilities
and supply. Education and training should provide new learning opportunities to
develop skills across professions.
31 32Overarching Themes Overarching Themes
Lessons Learnt from COVID-19: How Must Education and Training Adapt?
Clinicians trained and worked together in the expanded COVID-19 team. Multi- There must be more opportunities for professions in teams to develop together to
professional skills-based training was an immediate response to service need, recognise shared competencies and to understand the unique attributes and skills
organised by themes and unbiased by individuals’ professional background. of professional colleagues.
This occurred in parallel with increased multi-professional leadership, e.g. New learning/training opportunities should be developed to meet the need for skills
Advanced Critical Care Practitioners in critical care. During COVID-19, an Advanced acquisition across professions, and inter-professional learning should be core from
Clinical Practitioner was seen as the expert, leading as well as supporting the work medical school and throughout training and development.
of the whole team.
There should be development and recognition of generic and generalist
Hierarchies were flattened, with doctors providing support to senior medical staff competencies across and within healthcare professions and proactive action to
from other disciplines and working effectively in teams led by other professionals. dissolve the hidden curriculum that maintains silo cultures.
Morale was improved in these teams, as they valued the vital contribution of all
professions.
The rapid reskilling of clinicians also highlighted that the workforce must be willing
to engage with both short-term and long-term skills development.
The pandemic provoked flexibility in the regulatory system, highlighting how
change could enable greater opportunities for team-based and interprofessional
learning.
33 34Overarching Themes Overarching Themes
Climate Change and Sustainable Healthcare
Population Health and
We heard that there is a need to recognise the health industry’s contribution to climate
Sustainable Healthcare change. Younger doctors and medical students voiced this most strongly, highlighting
the different values placed on different elements of a doctor’s role by different
generations. Sustainable healthcare should provide good quality care while balancing
the economic, environmental, and social constraints and demands within health care
settings.
Adopting a Population Health Approach The Future Doctor will need the skills to be confident in resource stewardship and
leadership in managing resources effectively in partnership with communities
We heard that in the future, doctors will require a much more detailed knowledge
and patients. Their education must enable them to apply principles of sustainable
of population health. This will enable them to work with health and care teams and
healthcare and population health to their medical practice.
communities to deliver healthcare that optimally uses resources to improve the
physical, mental and social wellbeing of the whole population they serve. Adopting
a population health approach will enable the future healthcare team to minimise
inequity and reduce health inequalities within and across a defined population.
Education and training for Future Doctors must promote population health and
Lessons Learnt from COVID-19:
stewardship competencies.
The lockdown has highlighted the benefits that a cleaner atmosphere may have
We heard that Future Doctors should focus more on reducing the occurrence of
on individual health outcomes and demonstrated how more home working and
ill-health, addressing the wider determinants of health and working collaboratively with
remote consultation can be adopted rapidly and could benefit climate change.
communities and partner agencies. The future multi-professional team will consider
the whole range of health determinants and wellbeing, including lifestyle behaviours, COVID-19 has highlighted long-standing health inequalities and their
social circumstances and environmental exposures. consequences, providing a driver for prioritising population and public health in
all healthcare training. The medical workforce must take responsibility for their
HEE’s National Population Health Fellowship for all healthcare professionals was
communities, their local populations as well as individuals, while demonstrating the
launched in 2020 and aims to develop a workforce who can lead the integration of
leadership and flexibility to work within, across, and above organisations.
population health into their working environments. The integration of Big Data and
population health management expertise will allow healthcare teams to use data to The response to the surge in the COVID-19 pandemic highlighted that doctors
analyse and inform the interaction with a specific population (e.g. frequent falls). required confident decision-making skills, as well as the ability to prioritise
interventions and manage complex multimorbidity in the context of finite resources.
Understanding population health will enable doctors to participate in regional decisions
with regard to the value of care and how best to allocate resources for optimum The pattern of the pandemic and care required across settings has illustrated
value and reduced inequality. Future Doctors will need training in a broad diagnostic opportunities to consider the provision of healthcare education in social care
approach which evaluates population and environmental factors on patient’s health settings and across care pathways with placements for students, foundation
and disease. Training must empower doctors to not only treat the individual patient but doctors and doctors in specialty training (for example, in public health, frailty and
also to help mitigate these broader determinants. geriatric care delivery).
35 36Overarching Themes Overarching Themes
How Must Education and Training Adapt? Adoption of Technology
Education and training must promote population health and stewardship
competencies to equip doctors to maximise care outcomes within finite resources.
Doctors should be trained to have a broad diagnostic approach that evaluates
population and environmental factors that can support a patient’s health and care
Building on The Topol Review
management choices, empowering doctors to not only treat the individual patient
but also to help mitigate these broader determinants of health. Although the integration of technology is not always positively perceived, we heard that
most see digital literacy as a basic future educational competence. Digital literacy is a
Doctors should be equipped with the understanding to apply the principles of
key stand of the National Information Board’s Building a Digital Ready Workforce.
sustainable healthcare and population health to their medical practice.
HEE’s digital capability framework has been developed to support the improvement of
the digital capabilities of all staff in health and care.
A major role for the future clinical team will be to harness technology ethically and
guide patients in its use to optimise patient and population healthcare outcomes and
reduce inequalities. There is potential for technology to facilitate collaboration and
flatten the hierarchy amongst different professions through sharing of information,
expertise and responsibility whilst supporting each profession to use their unique skills.
There was widespread support for adopting the recommendations in ‘The Topol Review’
Preparing the healthcare workforce to deliver the digital future to ensure Future Doctors
are equipped with an understanding of genomics, artificial intelligence and digital
medicine.
The review’s three principles support the deployment of digital healthcare technologies
throughout the NHS:
Patients included as partners and informed about health technologies, with a
particular focus on vulnerable/marginalised groups to ensure equitable access.
Development of healthcare workforce expertise and guidance to evaluate new
technologies mirroring the use of evidence to evaluate clinical advances.
The adoption of new technologies should enable staff to gain more time to care.
37 38Overarching Themes Overarching Themes
We heard that Future Doctors must take an active role in the development of AI
technologies, working with a broader healthcare team to ensure the benefits are
maximised and risks minimised.(28) It is believed that AI will help standardise many How Must Education and Training Adapt?
aspects of clinical care, optimise processes, and allow clinical data to better inform
practice and outcomes.(29) However, there is concern that it will be challenging to Education and training must rapidly incorporate digital and technological solutions
ensure this will also reduce the administrative burden and increase clinical time. effectively; for example, increased online learning, assessment and simulation-
based education and training, remote induction, workplace orientation and
There is significant potential to enhance education and training by incorporating
supervision.
technological solutions, such as online learning, assessment and simulation-based
training and remote induction, workplace orientation and supervision. Enhanced digital Enhanced digital and simulation-led learning should be used to support the
and simulation-led learning for Future Doctors should develop complex problem integration of complex problem solving and improve multi-professional team-
solving and improve multi-professional team working. working and learning
Lessons Learnt from COVID-19:
The COVID-19 pandemic accelerated the adoption of digital and technological
solutions to delivering healthcare, education and training.
Training staff working at Nightingale Hospitals have provided the NHS with suites
of new educational learning environments and resources, and with insight into the
effective and rapid upskilling of individuals across professional boundaries through
‘demand relevant’ targeted interventions.
High quality e-learning (HEE’s eLfH) provided clear benefits and accelerated
acceptance of blended learning as a default model for medical education and
training.
Virtual recruitment, assessment and review processes enabled trainees to progress
and educators to attend meetings. This presents a solution to recent difficulties in
releasing clinical educator time and reducing the travel burden on both trainees
and educators. Technology-enhanced training, with central guidance and
resources, could become a core vehicle to deliver planned teaching. Although
core, this will not replace face-to-face contact, which enables development of key
relationships, effective working and learning.
39 40Overarching Themes Overarching Themes
Lifelong Career Framework
Flexibility in Working and
Flexibility is needed, not just for doctors in training, but also for consultants and GPs
Balanced Professional Lives wanting to maintain interest and enthusiasm throughout long and challenging careers.
The principles of flexible working, portfolio careers and opportunities to train and adapt
working practices need to be embedded across healthcare to sustain a future medical
workforce.
We explored the entire career span of doctors from undergraduate to healthy
The flexible training agenda remains central to HEE’s work in Enhancing Junior Doctor’s retirement. Many doctors emphasised concern about the recognition of the needs
Working Lives. The Future Doctor Programme highlighted the need to extend the pace of mature or ageing doctors who are towards the end of their career and the need
and scale of these initiatives so that flexibilities can be accelerated and spread. to adapt working patterns and support them to enable retention of these highly
Greater flexibility in working patterns and training pathways were consistently experienced individuals.
emphasised throughout the Future Doctor Programme as an important expectation for
doctors and medical students about their future careers. Supportive Culture
Respondents consistently supported a model that enabled doctors to step off the We heard repeatedly that establishing a supportive culture and safe system for the
training pathway, pause training, gain other competencies or pursue other interests or future clinical team to work in is critical to sustaining a healthy and happy healthcare
responsibilities, and then to restart training and have competencies taken into account. workforce,(30,31) as highlighted by HEE’s NHS Staff and Learners’ Mental Wellbeing
Commission.(30,31) The patient voice reinforced this by saying that patients expect
We heard that the ability to pursue a portfolio career in which healthcare
service delivery is integrated with, for example, medical education, academia, doctors to attend to their own wellbeing, so that they maintain the resilience to manage
entrepreneurship, or digital development would support a life-long medical career and a challenging career and be fully able to provide individualised, compassionate
the retention of a diverse, motivated, innovative workforce within the NHS. and high-quality care. Much greater attention to trainee wellbeing is required in the
management of education and training for Future Doctors.
Working patterns that promote time to hone craft skills and develop wider clinical
practice will both maintain interest and allow career pathways that can adapt to
change and respond to patient and population needs. Education and training for
Future Doctors should meet the expectations of a flexible medical career, as this is vital
to enabling adaptive change and retaining the medical workforce.
41 42Overarching Themes Overarching Themes
Lessons Learnt from COVID-19: How Must Education and Training Adapt?
Workforce wellbeing was recognised as a risk early on in the pandemic, and the The flexibilities being introduced through the enhancing junior doctors working lives
NHS responded by maintaining a focus on support, providing resources need to be accelerated and adopted fully across the NHS.
for developing resilience in high-pressure settings, and providing more basic
Meeting the expectations of a flexible medical career is vital to enabling adaptive
welfare support such as rest spaces. This was also built into trusts’ surge planning
change and to retaining the medical workforce, including valuing the expertise of
for intensive care services. Consideration of junior doctors’ wellbeing needs must
senior doctors in educational activities.
continue and be incorporated into the planning for the restart, recovery and any
reconfiguration of services. There must be greater attention to trainee wellbeing in the management of
education and training.
COVID-19 has highlighted the benefits of allowing doctors to build portfolio careers,
enabling transferable skills and capabilities, delivering a broader clinical pool
of expertise for emergency or pandemic situations. To enable portfolio careers,
individual development and service response should not be constrained by defined
curriculum requirements.
The NHS assessed the COVID-19 risk to staff and adapted job plans to reduce
patient contact, demonstrating the ability to deploy staff flexibly to support the
needs of individuals, while maintaining high-quality care.
Retired doctors were ready to return to practice in remote clinical or non-clinical
education roles during COVID-19, while some senior staff in high-risk groups
were required to shield. This highlighted the potential for doctors to contribute to
education in the later stage of their careers, when front line care may no longer be
feasible or desirable.
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